Fillable Form 111: BILL KEMP www.SumnerTags.com SUMNER COUNTY NOTARY (Sumner County Clerk)

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Form 111: BILL KEMP www.SumnerTags.com SUMNER COUNTY NOTARY (Sumner County Clerk)

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____________
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This applicant must sign under oath (We can notarize your form in our office) and submit to the
County Clerk's office 12:00 noon prior to the meeting of the County Legislative Body at which it is to be
considered. You are required to appear in the Clerk's office to take the oath and pay a $12.00 fee.
At that time, you are required to post a $10,000 surety bond. You are not authorized to act as a
Notary Public until you have received your commission from the Governor. If you move your
residence or your principal place of business out of this county, you are required by law to notify
the County Clerk of the change of address.
ANSWER EVERY QUESTION. (Please print or type.)
Full Name (as it will appear on your notary commission)
First Middle Last
Residence Address:
City: State: Zip:
Name of Employer:
Principal Business Address:
City: State: Zip:
Telephone: (home) (business)
(Applicant must 18 years old at the date of election)
PLEASE ANSWER THE FOLLOWING QUESTIONS (Yes or No):
1. Have you ever been convicted of offering or giving a bribe, larceny, or
any other offense declared infamous by law?
2. If the answer to question 1 was YES, has your citizenship been restored?
Date of Birth:
web-site:
www.SumnerTags.com
Yes / No
BILL KEMP
SUMNER COUNTY CLERK
355 N. Belvedere Dr. Roo
m
111
Gallatin, TN 37066
Phone: (615) 452-4063
Fax: (615) 452-9371
SUMNER COUNTY NOTARY PUBLIC APPLICATION
2008/07
Sumner County Notary Application
Page 1
CONTINUE ON BAC
K
3. Is there an unpaid judgment against you for money received in an official
capacity and due to the United States, to Tennessee or any Tennessee
county, or are you a defaulter to the treasury?
4. Are you a soldier, seaman, marine, or airman in the regular Army, Navy,
or Air Force of the United States, a member of the United States Congress,
or a person holding an office of profit or trust under any foreign power, other
state or the United States?
5. Have you ever been removed from office as a notary public for official
misconduct?
6. Have you ever had a notarial commission revoked or suspended by this
or any other state?
7. Have you ever been found by a court of this state or any other state to have
engaged in the unauthorized practice of law?
8. Is there any other reason that you are legally disqualified from holding the
office of a notary public?
I DO SWEAR OR AFFIRM UNDER PENALTIES OF PERJURY THAT I AM A UNITED STATES CITIZEN
OR LEGAL PERMANENT RESIDENT AND THE ABOVE STATEMENTS ARE TRUE AND CORRECT.
State of Tennessee
County of Sumner
Personally appeared before me, ____________________________, with whom I am personally
acquainted, and who acknowledged that he/she executed the within instrument for the purposes
therein contained.
Witness my hand, at office, this _______ day of ________________________, 20_____.
My Commission Expires: ___________________
For additional Notary Information: www.state.tn.us/sos/bus_svc/notary.htm
Yes / No
Signature of Applicant
Notary Public
2008/07
Sumner County Notary Application
Page 2
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Form 111: BILL KEMP www.SumnerTags.com SUMNER COUNTY NOTARY (Sumner County Clerk)

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Completed 5 July 2021

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